England faces undiagnosed hypertension: study finds 37% have high blood pressure and urges routine BP checks

New analysis of around 1.4 million adults in England finds that 37% have hypertension, and among them 59% had not previously been diagnosed or treated. The data, drawn from Our Future Health, underscores how BP can be measured cheaply and conveniently, yet awareness remains low and uptake of checks uneven.

• Hypertension affects 37% of the study population; after age adjustment, men show higher rates (42%) than women (29%).
• Among those taking BP-lowering drugs, about half still have high BP, highlighting gaps in treatment effectiveness or adherence.
• Surveys show 44% of adults over 40 are unaware free pharmacy BP checks exist and 59% did not realise they could access one without an appointment.
• The article argues for making BP measurement routine in everyday healthcare interactions and expanding testing beyond a 40+ target to younger adults as well.

Author: The Conversation. Original publication: The Conversation.

Overview

The article discusses a large UK study conducted via Our Future Health, which recruited about 1.4 million adults in England. The findings indicate that 37% have hypertension, and of these, 59% had not previously been diagnosed nor were they on BP-lowering medication. Hypertension becomes more common with age, rising from 15% in 18-39 year-olds to 71% in those 80 and older. After adjusting for age, men show higher prevalence (42%) than women (29%). Even among people already on treatment, roughly half still have elevated blood pressure.

The study’s scale is striking, but the cohort is not nationally representative since Our Future Health is a volunteer research group. Nevertheless, the results underscore a substantial public health challenge: many adults live with potentially dangerous hypertension without knowing it.

Key findings and context

Hypertension is commonly called a silent killer because most people experience no symptoms. Persistently high pressure damages vessels and raises the risk of heart disease, stroke, kidney disease, and vascular dementia. The NHS has implemented the Community Pharmacy Hypertension Case-Finding Service since 2021, offering free BP checks to people aged 40 and over who have not been diagnosed with hypertension. The article notes that this is sensible given pharmacies are community hubs and patients often visit them for routine care rather than GP appointments.

The piece also highlights a gap between the availability of BP checks and public uptake. NHS England surveys show that 44% of over-40s are unaware they can get a free BP check at a pharmacy, and 59% do not realise they can access it without an appointment. Moreover, testing often focuses on those 40+, while the study found hypertension in more than 15% of 18- to 39-year-olds, suggesting a need to broaden screening to younger populations, especially men who appear more likely to remain undiagnosed.

Implications for policy and practice

The article argues for a cultural shift where BP measurement becomes routine in everyday healthcare encounters, such as during repeat prescriptions, vaccinations, or health reviews. It also discusses the role of home BP monitoring and ambulatory (24-hour) monitoring as recommended by NICE when office measurements are inconclusive. Home monitoring remains susceptible to variability, so repeated measurements over time are advised to confirm hypertension.

Pathways forward

Potential steps include extending BP measurement beyond pharmacies to dentists, optometrists, workplaces, and other community settings. The NHS already allows referrals from GPs and other professionals to pharmacy BP checks, and there is a push to normalise measuring BP as a routine part of care to catch undiagnosed cases earlier and reduce cardiovascular risk across the population.

Takeaways

Technological and logistical tools are widely available to tackle undiagnosed hypertension, but a cultural shift is needed so people regard knowing their BP as a normal health checkbox, similar to regular height and weight checks. The emphasis on routine measurement and broader screening could help close the gap between BP measurement capability and actual diagnosis and treatment.

Author: The Conversation. Original publication: The Conversation.